Patient positioning support structure

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. application Ser. No. 13/317,012 filed Oct. 6, 2011, now U.S. Pat. No. 8,719,979, entitled Patient Positioning Support Structure, which application is a continuation of U.S. Ser. No. 12/460,702, filed Jul. 23, 2009, now U.S. Pat. No. 8,060,960, which is a continuation of U.S. Ser. No. 11/788,513, filed Apr. 20, 2007, now U.S. Pat. No. 7,565,708, which claims the benefit of U.S. Provisional Application No. 60/798,288 filed May 5, 2006 and is also a continuation-in-part of U.S. patent application Ser. No. 11/159,494 filed Jun. 23, 2005, now U.S. Pat. No. 7,343,635, which is a continuation-in-part of U.S. patent application Ser. No. 11/062,775 filed Feb. 22, 2005, now U.S. Pat. No. 7,152,261. The disclosures of all the preceding applications and patents are incorporated by reference herein.

BACKGROUND OF THE INVENTION

The present invention is directed to structure for use in maintaining a patient in a desired position during examination and treatment, including medical procedures such as imaging and surgery and in particular to such a structure that allows a surgeon to selectively position the patient for convenient access to the surgery site and providing for manipulation of the patient during surgery including the tilting, pivoting, angulating or bending of a trunk of a patient in a supine, prone or lateral position.

Current surgical practice incorporates imaging techniques and technologies throughout the course of patient examination, diagnosis and treatment. For example, minimally invasive surgical techniques, such as percutaneous insertion of spinal implants, involve small incisions that are guided by continuous or repeated intra-operative imaging. These images can be processed using computer software programs that produce three dimensional images for reference by the surgeon during the course of the procedure. If the patient support surface is not radiolucent or compatible with the imaging technologies, it may be necessary to interrupt the surgery periodically in order to remove the patient to a separate surface for imaging followed by transfer back to the operating support surface for resumption of the surgical procedure. Such patient transfers for imaging purposes may be avoided by employing radiolucent and other imaging compatible systems. The patient support system should also be constructed to permit unobstructed movement of the imaging equipment and other surgical equipment around, over and under the patient throughout the course of the surgical procedure without contamination of the sterile field.

It is also necessary that the patient support system be constructed to provide optimum access to the surgical field by the surgery team. Some procedures require positioning of portions of the patient's body in different ways at different times during the procedure. Some procedures, for example, spinal surgery, involve access through more than one surgical site or field. Since all of these fields may not be in the same plane or anatomical location, the patient support surfaces should be adjustable and capable of providing support in different planes for different parts of the patient's body as well as different positions or alignments for a given part of the body. Preferably, the support surface should be adjustable to provide support in separate planes and in different alignments for the head and upper trunk portion of the patient's body, the lower trunk and pelvic portion of the body as well as each of the limbs independently.

Certain types of surgery, such as orthopedic surgery, may require that the patient or a part of the patient be repositioned during the procedure while in some cases maintaining the sterile field. Where surgery is directed toward motion preservation procedures, such as by installation of artificial joints, spinal ligaments and total disc prostheses, for example, the surgeon must be able to manipulate certain joints while supporting selected portions of the patient's body during surgery in order to facilitate the procedure. It is also desirable to be able to test the range of motion of the surgically repaired or stabilized joint and to observe the gliding movement of the reconstructed articulating prosthetic surfaces or the tension and flexibility of artificial ligaments and other types of dynamic stabilizers before the wound is closed. Such manipulation can be used, for example, to verify the correct positioning and function of an implanted prosthetic disc or joint replacement during a surgical procedure. Where manipulation discloses binding, sub-optimal position or even crushing of the adjacent vertebrae, for example, as may occur with osteoporosis, the prosthesis can be removed and the adjacent vertebrae fused while the patient remains anesthetized. Injury which might otherwise have resulted from a “trial” use of the implant post-operatively will be avoided, along with the need for a second round of anesthesia and surgery to remove the implant or prosthesis and perform the revision, fusion or corrective surgery.

There is also a need for a patient support surface that can be rotated, articulated and angulated so that the patient can be moved from a prone to a supine position or from a prone to a 90° position and whereby intra-operative extension and flexion of at least a portion of the spinal column can be achieved. The patient support surface must also be capable of easy, selective adjustment without necessitating removal of the patient or causing substantial interruption of the procedure.

For certain types of surgical procedures, for example spinal surgeries, it may be desirable to position the patient for sequential anterior and posterior procedures. The patient support surface should also be capable of rotation about an axis in order to provide correct positioning of the patient and optimum accessibility for the surgeon as well as imaging equipment during such sequential procedures.

Orthopedic procedures may also require the use of traction equipment such as cables, tongs, pulleys and weights. The patient support system must include structure for anchoring such equipment and it must provide adequate support to withstand unequal forces generated by traction against such equipment.

Articulated robotic arms are increasingly employed to perform surgical techniques. These units are generally designed to move short distances and to perform very precise work. Reliance on the patient support structure to perform any necessary gross movement of the patient can be beneficial, especially if the movements are synchronized or coordinated. Such units require a surgical support surface capable of smoothly performing the multi-directional movements which would otherwise be performed by trained medical personnel. There is thus a need in this application as well for integration between the robotics technology and the patient positioning technology.

While conventional operating tables generally include structure that permits tilting or rotation of a patient support surface about a longitudinal axis, previous surgical support devices have attempted to address the need for access by providing a cantilevered patient support surface on one end. Such designs typically employ either a massive base to counterbalance the extended support member or a large overhead frame structure to provide support from above. The enlarged base members associated with such cantilever designs are problematic in that they may obstruct the movement of C-arm mobile fluoroscopic imaging devices. Surgical tables with overhead frame structures are bulky and may require the use of dedicated operating rooms, since in some cases they cannot be moved easily out of the way. Neither of these designs is easily portable or storable.

Thus, there remains a need for a patient support system that provides easy access for personnel and equipment, that can be easily and quickly positioned and repositioned in multiple planes without the use of massive counterbalancing support structure, and that does not require use of a dedicated operating room.

SUMMARY OF THE INVENTION

The present invention is directed to a patient support system that permits adjustable positioning, repositioning and selectively lockable support of a patient's head and upper body, lower body and limbs in up to a plurality of individual planes while permitting tilting, rotation, angulation or bending and other manipulations as well as full and free access to the patient by medical personnel and equipment. The system of the invention includes at least one support end or column that is height adjustable. The illustrated embodiment includes a pair of independently height-adjustable end support columns. The columns may be independent or connected to a horizontally length-adjustable base. One support column according to the invention may be coupled with a wall mount or other stationary support. A patient support structure is connected to and bridges substantially between the pair of end supports. The support structure may be a frame or other patient support having at least first and second hingable or pivotally connected portions, the first and second portions being selectively lockable in a first substantially planar orientation along a longitudinal axis of the support structure. The first and second portions are also positionable and lockable in a plurality of angles with respect to one another, with each portion being movable to a position on either side of the first planar orientation. In other words, the patient support structure is capable of hinging or otherwise bending to form an angulation or break, either upwardly or downwardly when the support structure is in a substantially horizontal position and also when the support structure is in an inclined position due to one of the support columns raising one end of the structure higher than another end. Of course, such a break may be from side-to-side when the support structure is rotated about a longitudinal axis thereof.

In a particular illustrated embodiment, angulation or breaking of the support structure is supported by a cable drive system (tension band suspension) that supports angulation using stationary end supports. Other embodiments include cantilevered systems with connected or unconnected movable or telescoping base supports. The first and second support structure portions may be in the form of frames, such as rectangular frames or other support structure that may be equipped with support pads for holding the patient, or other structure, such as imaging tops.

The patient support structure and the support column or columns are coupled with respective rotation, articulation or angulation adjustment structure for positioning the first support portion with respect to a first column or end support and with respect to the second support portion and the second support portion with respect to the second column or end support. Rotation adjustment structure in cooperation with pivoting and height adjustment structure provide for the lockable positioning of the first and second patient support portions at a variety of selected positions and articulations with respect to the support columns including angulation coupled with Trendelenburg and reverse Trendelenburg configurations as well as providing for patient roll over in horizontal or tilted orientation. Lateral movement (toward and away from a surgeon) may also be provided by a bearing block feature. A pair of patient support structures (such as a support frame and an imaging table) may be mounted between end supports of the invention and then rotated in unison about a longitudinal axis to achieve 180° repositioning of a patient, from a prone to a supine position.

Various objects and advantages of this invention will become apparent from the following description taken in relation to the accompanying drawings wherein are set forth, by way of illustration and example, certain embodiments of this invention.

The drawings constitute a part of this specification, include exemplary embodiments of the present invention, and illustrate various objects and features thereof.

BRIEF DESCRIPTION OF THE DRAWINGS

<figref idref="DRAWINGS">FIG. 1</figref> is a perspective view of a patient support structure according to the invention.

<figref idref="DRAWINGS">FIG. 2</figref> is an enlarged and partial side elevational view of a portion of the support structure of <figref idref="DRAWINGS">FIG. 2</figref>.

<figref idref="DRAWINGS">FIG. 3</figref> is an enlarged and partial top plan view of the support structure of <figref idref="DRAWINGS">FIG. 1</figref>.

<figref idref="DRAWINGS">FIG. 4</figref> is an enlarged and partial perspective view of a portion of the structure of <figref idref="DRAWINGS">FIG. 1</figref>.

<figref idref="DRAWINGS">FIG. 5</figref> is an enlarged and partial side elevational view of a portion of the structure of <figref idref="DRAWINGS">FIG. 1</figref>.

<figref idref="DRAWINGS">FIG. 6</figref> is an enlarged and partial perspective view of a portion of the structure of <figref idref="DRAWINGS">FIG. 1</figref>.

<figref idref="DRAWINGS">FIG. 7</figref> is an enlarged and partial perspective view of a first hinge of the structure of <figref idref="DRAWINGS">FIG. 1</figref>.

<figref idref="DRAWINGS">FIG. 8</figref> is an enlarged and partial perspective view of a cooperating second hinge of the structure of <figref idref="DRAWINGS">FIG. 1</figref>.

<figref idref="DRAWINGS">FIG. 9</figref> is an enlarged and partial elevational view of the hinge of <figref idref="DRAWINGS">FIG. 7</figref>.

<figref idref="DRAWINGS">FIG. 10</figref> is an enlarged and partial perspective view of an outer portion of the hinge of <figref idref="DRAWINGS">FIG. 7</figref> with portions broken away to show the detail thereof.

<figref idref="DRAWINGS">FIG. 11</figref> is an enlarged and partial perspective view of an inner portion of the hinge of <figref idref="DRAWINGS">FIG. 7</figref> with portions broken away to show the detail thereof.

<figref idref="DRAWINGS">FIG. 12</figref> is an enlarged and partial perspective view of a portion of the structure of <figref idref="DRAWINGS">FIG. 1</figref> showing a cable drive motor and winch cylinders.

<figref idref="DRAWINGS">FIG. 13</figref> is a partial perspective view of a patient support frame of the structure of <figref idref="DRAWINGS">FIG. 1</figref>.

<figref idref="DRAWINGS">FIG. 14</figref> is a partial perspective view of a patient imaging top for replacement with the patent support frame of <figref idref="DRAWINGS">FIG. 13</figref>.

<figref idref="DRAWINGS">FIG. 15</figref> is a reduced perspective view of the structure of <figref idref="DRAWINGS">FIG. 1</figref> shown with an imaging top of <figref idref="DRAWINGS">FIG. 14</figref> replacing the support frame of <figref idref="DRAWINGS">FIG. 13</figref> and shown in a planar inclined position.

<figref idref="DRAWINGS">FIG. 16</figref> is a perspective view of the structure of <figref idref="DRAWINGS">FIG. 15</figref> shown in a planar tilted position.

<figref idref="DRAWINGS">FIG. 17</figref> is a perspective view of the structure of <figref idref="DRAWINGS">FIG. 15</figref> shown in a planar inclined and tilted position.

<figref idref="DRAWINGS">FIG. 18</figref> is a side elevational view of the structure of <figref idref="DRAWINGS">FIG. 15</figref> shown in a symmetrical upward breaking position.

<figref idref="DRAWINGS">FIG. 19</figref> is a side elevational view of the structure of <figref idref="DRAWINGS">FIG. 15</figref> shown in a first inclined and upward breaking position.

<figref idref="DRAWINGS">FIG. 20</figref> is a side elevational view of the structure of <figref idref="DRAWINGS">FIG. 15</figref> shown in a second inclined and upward breaking position.

<figref idref="DRAWINGS">FIG. 21</figref> is a side elevational view of the structure of <figref idref="DRAWINGS">FIG. 15</figref> shown in a symmetrical downward breaking position.

<figref idref="DRAWINGS">FIG. 22</figref> is a side elevational view of the structure of <figref idref="DRAWINGS">FIG. 15</figref> shown in a first inclined and downward breaking position.

<figref idref="DRAWINGS">FIG. 23</figref> is a side elevational view of the structure of <figref idref="DRAWINGS">FIG. 15</figref> shown in a second inclined and downward breaking position.

<figref idref="DRAWINGS">FIG. 24</figref> is an enlarged side elevational view of the structure of <figref idref="DRAWINGS">FIG. 1</figref> shown in an upward breaking, inclined and tilted position.

<figref idref="DRAWINGS">FIG. 25</figref> is a is a perspective view of a second embodiment of a patient support structure according to the invention.

<figref idref="DRAWINGS">FIG. 26</figref> is a perspective view of the patient support structure of <figref idref="DRAWINGS">FIG. 25</figref> shown tilted in an intermediate position during a rotation as would be used for a patient rollover.

<figref idref="DRAWINGS">FIG. 27</figref> is a perspective view of the structure of <figref idref="DRAWINGS">FIG. 25</figref> shown further tilted in a second intermediate position during rotation.

<figref idref="DRAWINGS">FIG. 28</figref> is a perspective view of the structure of <figref idref="DRAWINGS">FIG. 25</figref> shown after rotation to a final flipped position.

<figref idref="DRAWINGS">FIG. 29</figref> is a front elevational view of a third embodiment of a patient support structure according to the invention.

<figref idref="DRAWINGS">FIG. 30</figref> is a front elevational view of a fourth embodiment of a patient support structure according to the invention.

<figref idref="DRAWINGS">FIG. 31</figref> is a perspective view of a fifth embodiment of a patient support structure according to the invention shown in a planar inclined position.

<figref idref="DRAWINGS">FIG. 32</figref> is a perspective view of the structure of <figref idref="DRAWINGS">FIG. 31</figref> shown in an inclined and upward breaking position.

<figref idref="DRAWINGS">FIG. 33</figref> is a perspective view of the structure of <figref idref="DRAWINGS">FIG. 31</figref> shown in a substantially symmetrical downward breaking position.

DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

As required, detailed embodiments of the present invention are disclosed herein; however, it is to be understood that the disclosed embodiments are merely exemplary of the invention, which may be embodied in various forms. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the present invention in virtually any appropriately detailed structure.

Referring now to the drawings, a patient positioning support structure according to the invention is generally designated by the reference numeral <b>1</b> and is depicted in <figref idref="DRAWINGS">FIGS. 1-12</figref>. The structure <b>1</b> includes first and second upright support piers or columns <b>3</b> and <b>4</b> which are illustrated as independent, stationary floor base support structures as shown in <figref idref="DRAWINGS">FIG. 1</figref> or may be connected to one another by a non-telescoping base support as illustrated in the embodiment shown in <figref idref="DRAWINGS">FIGS. 25-28</figref>. In some embodiments according to the invention as shown, for example, in <figref idref="DRAWINGS">FIGS. 31-33</figref>, the base connection places the columns in a selectively telescoping relationship. It is also foreseen that in certain embodiments according to the invention, one of the support columns may be replaced by a conventional operating table support, or may even be a wall mount. In the illustrated embodiment, the upright support column <b>3</b> is connected to a first support assembly, generally <b>5</b>, and the upright support column <b>4</b> is connected to a second support assembly, generally <b>6</b>. Between them, the support assemblies <b>5</b> and <b>6</b> uphold an elongate and angulatable or breaking patient holding or support structure, generally <b>10</b> and optionally, a removable patient support structure that will be described with respect to another embodiment of the invention. The illustrated support structure <b>10</b> includes a first frame section <b>12</b>, a second frame section <b>14</b> with a transverse support cross bar <b>15</b>, and a pivot or hinge assembly, generally <b>16</b>. In the illustrated embodiment, the pivot assembly further includes a cable drive system including a dual winch <b>18</b> and cooperating cables <b>20</b>.

The columns <b>3</b> and <b>4</b> are supported by outwardly extending feet <b>22</b> that may or may not include spaced apart casters or wheels (not shown) each equipped with a floor-lock foot lever for lowering the feet <b>12</b> into a floor-engaging position as shown in <figref idref="DRAWINGS">FIG. 1</figref>. The columns <b>3</b> and <b>4</b> each include two or more telescoping lift arm segments <b>3</b><i>a</i>, <b>3</b><i>b </i>and <b>4</b><i>a</i>, <b>4</b><i>b</i>, respectively that permit the height of each of the columns <b>3</b> and <b>4</b> to be selectively increased and decreased in order to raise and lower all or a selected portion of the connected patient support structure <b>10</b>. It is foreseen that the vertical supports <b>3</b> and <b>4</b> may be constructed so that the column <b>3</b> has a greater mass than the support column <b>4</b> or vice versa in order to accommodate an uneven weight distribution of the human body. Such reduction in size at the foot end of the system <b>1</b> may be employed in some embodiments to facilitate the approach of personnel and equipment.

Each of the support assemblies <b>5</b> and <b>6</b> generally includes a rotation subassembly <b>26</b> and <b>26</b>′ and an angulation subassembly <b>27</b> and <b>27</b>′, respectively, that are interconnected as will be described in greater detail below and include associated power source and circuitry linked to a controller <b>29</b> (<figref idref="DRAWINGS">FIG. 1</figref>) for cooperative and integrated actuation and operation. The rotational subassemblies <b>26</b> and <b>26</b>′ enable coordinated rotation of the patient support structure <b>10</b> about a longitudinal axis. The angulation subassemblies <b>27</b> and <b>27</b>′ enable the selective hinging or breaking of the support <b>10</b> by the hinge assembly <b>16</b> at desired levels and increments as well as selective tilting of the longitudinal axis of the frame portion <b>12</b> or <b>14</b>. The rotation subassembly or mechanism <b>26</b> is shown in <figref idref="DRAWINGS">FIG. 5</figref> and includes at least one motor housing <b>30</b> surmounting the support column <b>3</b>. In the illustrated embodiment, only one rotational motor is provided, but it is foreseen that a cooperating motor may also be mounted on the support column <b>4</b>. A main rotational shaft <b>32</b> extends from the motor housing <b>30</b> that turns a rotation structure <b>33</b>. The rotation structure <b>33</b> in turn rotates the connected patient support <b>10</b> about a longitudinal axis as will be described in greater detail below. The motor housing <b>30</b> contains a rotary electric motor or other actuator drivingly engaged with the shaft <b>32</b>. The rotation mechanism <b>26</b> is operated by actuating the motor using a switch or other similar means. The rotation structure <b>33</b> is fixed to the shaft <b>32</b> at a location spaced from the motor housing <b>30</b> and the support column <b>3</b> to provide clearance for rotation of the connected patient support structure <b>10</b>.

As shown in <figref idref="DRAWINGS">FIG. 5</figref>, the rotation structure <b>33</b> is attached to a pair of translation posts or H-bar posts <b>40</b> disposed at either end of the rotation structure <b>33</b>. The posts <b>40</b> are each attached to the structure <b>33</b> by a pin <b>42</b>, bolt, or other fixing structure. A plurality of cooperating apertures <b>44</b> formed in the posts <b>40</b> provide passageway for a pivot pin <b>46</b> to extend therethrough. The pivot pin <b>46</b> is receivable in each cooperating pair of apertures <b>44</b> allowing for selective placement of a translation connector <b>48</b> that is sized and shaped to be received between the pair of posts <b>40</b> and also receive the pivot pin <b>46</b> therethrough. The pin <b>46</b> and connector <b>48</b> are thus positionable in an orientation transverse to the longitudinal extension of the support <b>10</b> at a variety of heights to be selected by the surgeon and readily changeable, even during surgery if necessary, to vary the height of the frame section <b>12</b>. The multiple location or height feature is also advantageous when more than one frame or patent structure is mounted in tandem as shown, for example in <figref idref="DRAWINGS">FIGS. 25-28</figref>. The position of the frame or other structure may be desirably changed to provide close proximity to an imaging top with a distance between a patient support and an imaging top being expandable or reduceable depending upon the size or other attributes of a patient and surgical or other requirements. As illustrated in <figref idref="DRAWINGS">FIG. 5</figref>, the connector <b>48</b> has a slot <b>50</b> for receiving the pivot pin <b>46</b>.

The translation connector <b>48</b> is in turn attached to a pivot connector <b>52</b>. The pivot connector <b>52</b> includes first and second outwardly opening and opposed slots <b>54</b> and <b>56</b>. The first slot <b>54</b> is sized and shaped for receiving the translation connector <b>48</b> and the second slot is sized and shaped for receiving an end connection <b>58</b> of the frame section <b>12</b>. The pivot connector <b>52</b> further includes a through aperture or bore <b>60</b> running substantially perpendicular to the slot <b>54</b> and communicating therewith. The aperture <b>60</b> is sized and shaped to receive a pivot pin <b>62</b> therethrough, allowing for some forward and rearward lateral movement of the attached frame end connection <b>58</b> and thus the frame section <b>12</b>, providing a degree of freedom and clearance needed for rotation the patient support about a longitudinal axis of a patient. The slot <b>56</b> is sized and shaped to frictionally engage the frame end connection <b>58</b>, thus securely fixing the end connection <b>58</b> to the pivot connector <b>52</b>. The frame end connection <b>58</b> is in turn fixed to each of elongate frame members <b>66</b> and <b>68</b> of the frame section <b>12</b>. The frame members <b>66</b> and <b>68</b> are each hingedly connected to the hinge assembly <b>16</b> to be described in greater detail below. Pivoting of the translation connector <b>48</b> with respect to the pin <b>46</b> provides for selected articulation of the frame section <b>12</b> (that includes the end connection <b>58</b> and the frame members <b>66</b> and <b>68</b>) and/or the entire support <b>10</b> with respect to the support pier or column <b>3</b>.

With reference to <figref idref="DRAWINGS">FIG. 6</figref>, at the support pier or column <b>4</b>, the support assembly <b>6</b> is substantially similar to the support assembly <b>5</b> with the exception that the rotation subassembly <b>26</b>′ is passive and therefore does not include a motor. However, the support pier or column <b>4</b> preferably includes a powered mechanism to provide selective height adjustment of the subassembly <b>26</b>′. A rotation structure <b>33</b>′ is spaced from and freely rotatable with respect to the column <b>4</b>. The structure <b>33</b>′ includes a shaft (not shown) extending outwardly therefrom similar to the rotation shaft <b>32</b>, the shaft being rotatingly received in an aperture in the support column <b>4</b>.

The rotation subassembly <b>26</b>′ and the angulation subassembly <b>27</b> otherwise include elements identical to or substantially similar to the elements of the subassemblies <b>26</b> and <b>27</b>. Specifically, H-bar posts <b>40</b>′, pin <b>42</b>′, apertures <b>44</b>′, pivot pin <b>46</b>′, translation connector <b>48</b>′, slot <b>50</b>′, pivot connector <b>52</b>′, end connector <b>58</b>′ and pivot pin <b>62</b>′, are identical or substantially similar in form and cooperate with other elements identically or substantially similarly to what has been described previously herein with respective H-bar posts <b>40</b>, pin <b>42</b>, apertures <b>44</b>, pivot pin <b>46</b>, translation connector <b>48</b>, slot <b>50</b>, pivot connector <b>52</b>, end connector <b>58</b> and pivot pin <b>62</b>.

The frame <b>14</b> further includes frame members <b>66</b>′ and <b>68</b>′ that are each fixed to the end connector <b>58</b>′. The frame members <b>66</b>′ and <b>68</b>′ are pivotably or hingedly connected to respective frame members <b>66</b> and <b>68</b> by the hinge assembly <b>16</b>. Specifically, the frame member <b>66</b> is attached to the frame member <b>66</b>′ by the hinge mechanism <b>70</b> and the frame member <b>68</b> is attached to the frame member <b>68</b>′ by the hinge mechanism <b>72</b>. With particular reference to FIGS. <b>7</b> and <b>9</b>-<b>11</b>, the hinge mechanism <b>70</b> includes an outer member <b>76</b> and an inner member <b>78</b>. The outer member <b>76</b> is fixed or may be integral with the elongate frame member <b>66</b>, while the inner member <b>78</b> is integral or otherwise fixed to the frame member <b>66</b>′. The outer member <b>76</b> further includes an extension <b>80</b> with a groove <b>82</b> for receiving and guiding the cable <b>20</b>. The extension <b>89</b> tapers in a direction from the outer member interior <b>84</b> to the groove <b>82</b>. The extension <b>89</b> is configured to cause a slight upward break or bend of the support <b>10</b> when the extension <b>89</b> comes into contact with the cable <b>20</b> at the groove <b>82</b>. In that way, when the cables <b>20</b> are reeled in to shorten the hypotenuse of the triangle formed by the cable, the section <b>12</b> and the section <b>14</b>, the sections <b>12</b> and <b>14</b> move toward one another, resulting in the upward break as illustrated, for example, in <figref idref="DRAWINGS">FIG. 18</figref>. The downward break illustrated, for example, in <figref idref="DRAWINGS">FIG. 21</figref> is a result of lengthening the cable <b>20</b> distance and allowing gravity to drop the hinge <b>70</b>. The extension <b>89</b> is shaped to extend slightly inwardly toward a longitudinal axis A of the support <b>10</b>, thereby guiding the cable <b>20</b> along a path within a periphery of the frame sections <b>12</b> and <b>14</b> when the extension <b>89</b> is in contact with the cable <b>20</b> when in a downward breaking configuration directed toward the cable with the cable <b>20</b> being received at the groove <b>82</b>.

It is foreseen that where an upward breaking (only) embodiment is desired according to the invention, the sections <b>12</b> and <b>14</b> may be positioned with respect to two end columns to always include a slight upward break or bend at the hinge or pivot between the sections <b>12</b> and <b>14</b>. When the telescoping base is actuated to move the columns toward one another, the sections <b>12</b> and <b>14</b> would automatically further break upwardly and toward one another. Downward breaking would not be possible in such an embodiment as the maximum distance between the two end columns would still ensure a slight upward break or hinge between the sections <b>12</b> and <b>14</b>. Such an embodiment would be acceptable for use because patient holding pads could be positioned on the frames <b>12</b> and <b>14</b> such that the patient would be in a substantially horizontal position even when there is a slight upward bend or break at the hinge between the sections <b>12</b> and <b>14</b>. Returning to the hinge <b>70</b> of illustrated embodiment, the inner member <b>78</b> is slidingly and rotatably receivable in an interior <b>84</b> of the outer member <b>76</b>. The outer member has a pair of pivot apertures <b>86</b> and the inner member has a pivot aperture <b>87</b>, the apertures cooperating to create a through bore for receiving a pivot pin <b>88</b> through both the inner and outer hinge members. The interior <b>84</b> includes a curved partially cylindrical surface <b>89</b> for slidingly receiving a cooperating outer rounded and partially cylindrical surface <b>90</b> of the inner member <b>78</b>. The inner member <b>78</b> further includes a downward breaking stop or projection <b>92</b> that limits a downward pivot (in a direction toward the cables <b>20</b>) of the hinge <b>70</b> in the event the cables <b>20</b> should fail. The stop <b>92</b> abuts against a surface <b>93</b> of the interior <b>84</b>. In the illustrated embodiment, the stop <b>92</b> limits the extent of rotation or hinging of the section <b>66</b> with respect to the section <b>66</b>′ to about twenty-five degrees. Upward pivot (in a direction away from the cables <b>20</b>) is limited by abutment of an inner planar surface <b>95</b> with a planar surface <b>96</b> of the hinge inner member <b>78</b>.

With particular reference to <figref idref="DRAWINGS">FIG. 8</figref>, the hinge mechanism <b>72</b> is substantially a mirror image of the hinge mechanism <b>70</b> and therefore includes the following elements: a hinge outer member <b>76</b>′, and inner member <b>78</b>′, and extension <b>80</b>′ with a groove <b>82</b>′, and interior <b>84</b>′ pivot apertures <b>86</b>′ and <b>88</b>′, a pivot pin <b>88</b>′, a curved surface <b>89</b>′, and outer surface <b>90</b>′, a stop <b>92</b>′, an abutment surface <b>93</b>′, an inner planar surface <b>95</b>′ and a planar surface <b>96</b>′. These elements are substantially similar in shape and function to the respective hinge outer member <b>76</b>, inner member <b>78</b>, extension <b>80</b>, groove <b>82</b>, interior <b>84</b>, pivot apertures <b>86</b> and <b>88</b>, pivot pin <b>88</b>, curved surface <b>89</b>, outer surface <b>90</b>, stop <b>92</b>, abutment surface <b>93</b>, inner planar surface <b>95</b> and planar surface <b>96</b> described herein with respect to the hinge <b>70</b>.

It is noted that other hinge or pivot mechanisms may be utilized in lieu of the hinge assembly <b>16</b>. For example, the polyaxial joint <b>95</b> illustrated and described in Applicant's pending U.S. patent application Ser. No. 11/062,775 filed Feb. 22, 2005, and pending U.S. patent application Ser. No. 11/159,494 filed Jun. 23, 2005, may be incorporated into the patient support structure <b>10</b> at the break between the sections <b>12</b> and <b>14</b>. Both of these U.S. applications (Ser. Nos. 11/062,775 and 11/159,494) are hereby incorporated by reference herein.

The cable drive system <b>18</b> includes a rotary motor <b>98</b> cooperating with and driving by rotation a pair of winch cylinders <b>99</b> disposed on either side of the motor <b>98</b>. The motor <b>98</b> and cylinders <b>99</b> are mounted to the end connector <b>58</b>′ located near the support column <b>4</b>. Each cable <b>20</b> is attached to one of the winch cylinders <b>99</b> at one end thereof and to the end connector <b>58</b> at the other end thereof. In a first longitudinal position wherein the section <b>12</b> is substantially planar with the section <b>14</b>, the cables <b>20</b> are wound about the winch cylinders <b>99</b> an amount to provide enough tension in the cables <b>20</b> to maintain such a substantially planar orientation and configuration, with the hinge extensions <b>82</b> and <b>82</b>′ being in contact with each of the cables <b>20</b>. The motor <b>98</b> is preferably low speed and high torque for safely winding both of the cables <b>20</b> simultaneously about the cylinders <b>99</b> to draw the section <b>12</b> toward the section <b>14</b> to result in an upward breaking configuration with the hinges <b>70</b> and <b>72</b> disposed in spaced relation with the cables <b>20</b> and the hinges <b>70</b> and <b>72</b>. The motor <b>98</b> may be reversed, reversing the direction of rotation of the winch cylinders <b>99</b> for slowly unwinding the cables <b>20</b> to a downward breaking configuration. As the cables <b>20</b> unwind, gravity draws the support sections <b>12</b> and <b>14</b> downward with the cables <b>20</b> being received in the grooves <b>82</b> and <b>82</b>′ of the hinge extensions <b>80</b> and <b>80</b>′. As the cables <b>20</b> slacken, the hinges <b>70</b> and <b>72</b> continue to lower pressing down upon the cables <b>20</b>.

It is noted that the frame sections <b>12</b> and <b>14</b> are typically equipped with pads (not shown) or other patient holding structure. Furthermore, with respect to <figref idref="DRAWINGS">FIGS. 13 and 14</figref>, the frame member sections <b>66</b> and <b>68</b> of section <b>12</b> and the frame member sections <b>66</b>′ and <b>68</b>′ of the section <b>14</b> may be replaced with substantially rectangular imaging tops or sections <b>100</b> and <b>101</b>′ respectively. Each of the sections <b>100</b> and <b>101</b>′ having elongate slots <b>101</b> formed therein to allow for attachment of the hinge mechanisms <b>70</b> and <b>72</b> in a manner identical or substantially similar to what has been described herein with respect to the frame sections <b>12</b> and <b>14</b>.

With reference to <figref idref="DRAWINGS">FIGS. 15-17</figref>, the imaging sections <b>100</b> and <b>100</b>′ are illustrated, replacing the frame sections <b>12</b> and <b>14</b> of the embodiment disclosed in <figref idref="DRAWINGS">FIGS. 1-12</figref>. Each of <figref idref="DRAWINGS">FIGS. 15-17</figref> represent configurations in which the cable drive <b>18</b> is tensioned such that the sections <b>100</b> and <b>100</b>′ are kept in a substantially coplanar configuration. <figref idref="DRAWINGS">FIG. 15</figref> illustrates a configuration in which the column <b>3</b> is telescoped upwardly with the frame sections hinging at the support assemblies <b>5</b> and <b>6</b>, resulting in an inclined position or configuration of the entire patient support. In the illustrated embodiment, the section <b>100</b> would preferably receive a patient's head. Therefore, <figref idref="DRAWINGS">FIG. 15</figref> illustrates a reverse Trendelenburg position or orientation. <figref idref="DRAWINGS">FIG. 16</figref> illustrates the sections <b>100</b> and <b>100</b>′ again in a substantially common plane with both sections being rotated to a tilted position produced by a powered rotation of the rotation the sub assemblies <b>26</b> and passive rotation of the assembly <b>26</b>′ with both columns <b>3</b> and <b>4</b> otherwise holding the sections <b>100</b> and <b>100</b>′ at the same height. <figref idref="DRAWINGS">FIG. 17</figref> illustrates both tilting due to rotation of the assemblies <b>26</b> and <b>26</b>′ and also a sloping or inclined position with the column <b>4</b> being extended vertically. Thus, <figref idref="DRAWINGS">FIG. 17</figref> illustrates a Trendelenburg position or orientation with both the sections <b>100</b> and <b>100</b>′ remaining in substantially the same plane.

With reference to <figref idref="DRAWINGS">FIGS. 18-20</figref>, there is illustrated three upward breaking or hinging configurations of the structure <b>1</b>. <figref idref="DRAWINGS">FIG. 18</figref> illustrates a symmetrical upward breaking configuration wherein the columns <b>3</b> and <b>4</b> are holding the respective support assemblies <b>5</b> and <b>6</b> at substantially the same height with the cables <b>20</b> being shortened by rotation of the winch motor to result in an upward break in the hinge assembly <b>16</b>. <figref idref="DRAWINGS">FIG. 19</figref> illustrates the column <b>3</b> being extended to a maximum height and the cables reeled to shorten a distance between the sections <b>100</b> and <b>100</b>′. An example of such an upward break with reverse Trendelenburg would be a head or column <b>3</b> height of 43 inches, a foot or column <b>4</b> height of 24 inches and a 35 degree upward break with zero degree roll. <figref idref="DRAWINGS">FIG. 20</figref> illustrates an upward breaking Trendelenburg with the column <b>4</b> being extended to a maximum height.

With reference to <figref idref="DRAWINGS">FIGS. 21-23</figref>, there is illustrated three downward breaking configurations of the structure <b>1</b>. <figref idref="DRAWINGS">FIG. 21</figref> illustrates a symmetrical downward breaking configuration wherein the columns <b>3</b> and <b>4</b> are holding the support assemblies <b>5</b> and <b>6</b> respectively, at the same height with the cables <b>20</b> being unwound or slackened to result in a downward break in the hinge assembly <b>16</b>, the hinges <b>70</b> and <b>72</b> contacting the cables <b>20</b>. <figref idref="DRAWINGS">FIG. 22</figref> illustrates a downward breaking reverse Trendelenburg with the column <b>3</b> being extended to a maximum height resulting in a patent's head end being at a maximum height. <figref idref="DRAWINGS">FIG. 23</figref> illustrates a downward breaking Trendelenburg with the column <b>4</b> being extended to a maximum height.

It is noted that in each of the configurations illustrated in <figref idref="DRAWINGS">FIGS. 18-23</figref>, the sub assemblies <b>26</b> may be rotated in either direction, resulting in a tilted or rotated as well as upwardly or downwardly broken or hinged configuration. For example, <figref idref="DRAWINGS">FIG. 24</figref> illustrates the structure <b>1</b> with support frame sections <b>12</b> and <b>14</b> positioned in a configuration similar to that illustrated in <figref idref="DRAWINGS">FIG. 19</figref>, but also including rotation, resulting in a tilting and upwardly breaking configuration of the structure <b>1</b>. An example of the position illustrated in <figref idref="DRAWINGS">FIG. 24</figref> would be: a head or column <b>3</b> height of 41 inches, a foot or column <b>4</b> height of 34 inches and a 35 degree upward break with 10 degree roll.

With reference to <figref idref="DRAWINGS">FIGS. 25-28</figref>, another structure, generally <b>102</b> according to the invention is illustrated. The structure <b>102</b> utilizes all of the elements described herein with respect to the structure <b>1</b> and therefore the same references numerals are used for the same elements or features. The structure <b>102</b> differs from the structure <b>1</b> in that the H-bar posts <b>40</b> and <b>40</b>′ are replaced or modified to be extended H-bar posts <b>40</b>A and <b>40</b>A′, allowing for the mounting of two elongate structure <b>10</b> and cooperating cable drives <b>18</b>. In the embodiment shown in <figref idref="DRAWINGS">FIG. 25</figref>, one of the structures <b>10</b> includes the frame member <b>12</b> and <b>14</b> while the other structure is an imaging top having sections <b>100</b> and <b>100</b>′. As previously described herein, the cooperating H-bar posts <b>40</b>A and <b>40</b>A′ equipped with a plurality of apertures allows for the placement of the support structures <b>10</b> at a variety of locations. As illustrated in <figref idref="DRAWINGS">FIGS. 25-28</figref>, the structure <b>102</b> provides for the complete rotation and thus a roll-over of a patient by actuation of the motor of the rotation subassembly <b>26</b> using the controller <b>29</b>. The structure <b>102</b> is further illustrated with a non-telescoping base support <b>110</b> fixed to each of the columns <b>3</b> and <b>4</b> and rollers or castors <b>112</b> at the base of the structure <b>102</b>.

With reference to <figref idref="DRAWINGS">FIGS. 29 and 30</figref>, another embodiment or system according to the invention, generally <b>200</b> is illustrated. The system <b>200</b> broadly includes an elongate length-adjustable base <b>202</b> surmounted at either end by respective first and second upright support piers or columns <b>203</b> and <b>204</b> which are connected to respective first and second support assemblies, generally <b>205</b> and <b>206</b>. Between them, the support assemblies <b>205</b> and <b>206</b> uphold an elongated breaking, hingable or pivotable patient support structure, generally <b>210</b>. The structure is described in detail in Applicants's pending U.S. patent application Ser. No. 11/062,775 filed Feb. 22, 2005, Ser. No. 11/159,494 filed Jun. 23, 2005, both of which are incorporated by reference herein. The embodiment <b>200</b>A illustrated in <figref idref="DRAWINGS">FIG. 30</figref> differs from the structure <b>200</b> only in that the length-adjustable base <b>202</b> is replaced by a first base <b>220</b> attached to the pier <b>203</b> and a second base <b>222</b> attached to the pier <b>204</b>. All of the bases <b>202</b>, <b>220</b> and <b>222</b> include castors or rollers <b>230</b> or some other movable structure to allow the piers <b>203</b> and <b>204</b> to move toward and away from one another during upward or downward breaking of the structure <b>210</b>.

It is foreseen that cable drives as described herein, other types of motor drives including screw drives, hydraulic systems, and the like, may be utilized to facilitate both upward and downward breaking of the support structure <b>210</b>.

Another patient support structure according to the invention, generally <b>301</b>, is illustrated in <figref idref="DRAWINGS">FIGS. 31-33</figref>. The structure <b>301</b> generally includes a horizontally telescoping floor mounted base <b>302</b>, a conventional or standard telescoping and inclinable operating table support structure <b>304</b>, a telescoping end support or pier <b>306</b> and a hinged or pivotally upwardly and downwardly breaking support structure <b>310</b> connected to both the structure <b>304</b> and the pier <b>306</b>. The patient support structure <b>310</b> further includes a first cantilevered section <b>312</b> and a second section <b>314</b>. The first section <b>312</b> is fixed to and extends from the operating table support <b>304</b>. The second section is attached to the pier <b>306</b> by a hinge or pivoting assembly <b>320</b>, such as the support assembly <b>5</b> described herein with respect to the structure <b>1</b>. The hinge mechanism <b>316</b> disposed between the support sections <b>312</b> and <b>314</b> may be a conventional hinge, pivot, or pivot or hinge systems previously described herein.

In use, the operating table support <b>304</b> utilizes electric or other power means to move the support section <b>312</b> up and down and at an incline, as is known in the art. In response to the movement of the section <b>312</b>, the section <b>314</b> also moves, resulting in upward and downward breaking illustrated in <figref idref="DRAWINGS">FIGS. 32 and 33</figref>. In response to the movement of the section <b>312</b>, the electric powered telescoping base <b>302</b> moves the pier <b>306</b> toward or away from the support <b>304</b>. The pier <b>306</b> includes a motor for raising and lowering the pier at the connection <b>320</b>.

As stated above with respect to other embodiments of the invention described herein, it is foreseen that cable drives as described herein, other types of drives including screw drives, hydraulic systems, and the like, may be utilized to facilitate both upward and downward breaking of the support structure <b>310</b>.

It is to be understood that while certain forms of the present invention have been illustrated and described herein, it is not to be limited to the specific forms or arrangement of parts described and shown.